|
HEAD HUMERAL 46MM*20MM
|
Facility
|
OP
|
$7,180.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.40 |
| Max. Negotiated Rate |
$6,892.80 |
| Rate for Payer: Aetna Commercial |
$5,528.60
|
| Rate for Payer: Anthem Medicaid |
$2,469.20
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$5,600.40
|
| Rate for Payer: Cash Price |
$3,590.00
|
| Rate for Payer: Cigna Commercial |
$5,959.40
|
| Rate for Payer: First Health Commercial |
$6,821.00
|
| Rate for Payer: Humana Commercial |
$6,103.00
|
| Rate for Payer: Humana KY Medicaid |
$2,469.20
|
| Rate for Payer: Kentucky WC Medicaid |
$2,494.33
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$5,887.60
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,298.84
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,154.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.74
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,318.40
|
| Rate for Payer: Ohio Health Group HMO |
$5,385.00
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,436.00
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$933.40
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,225.80
|
| Rate for Payer: PHCS Commercial |
$6,892.80
|
| Rate for Payer: United Healthcare All Payer |
$6,318.40
|
|
|
HEAD HUMERAL 48MM*19MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 48MM*19MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 48MM*21MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 48MM*21MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 50MM*19MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 50MM*19MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 50MM*21MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 50MM*21MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 52MM*20MM
|
Facility
|
OP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem Medicaid |
$3,159.58
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Humana KY Medicaid |
$3,159.58
|
| Rate for Payer: Kentucky WC Medicaid |
$3,191.74
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,222.98
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 52MM*20MM
|
Facility
|
IP
|
$9,187.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,194.38 |
| Max. Negotiated Rate |
$8,820.00 |
| Rate for Payer: Aetna Commercial |
$7,074.38
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,166.25
|
| Rate for Payer: Cash Price |
$4,593.75
|
| Rate for Payer: Cigna Commercial |
$7,625.62
|
| Rate for Payer: First Health Commercial |
$8,728.12
|
| Rate for Payer: Humana Commercial |
$7,809.38
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,533.75
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,780.38
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,756.25
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,085.00
|
| Rate for Payer: Ohio Health Group HMO |
$6,890.62
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,837.50
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,194.38
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,848.12
|
| Rate for Payer: PHCS Commercial |
$8,820.00
|
| Rate for Payer: United Healthcare All Payer |
$8,085.00
|
|
|
HEAD HUMERAL 52MM*22MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 52MM*22MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 54MM*21MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 54MM*21MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 54MM*23MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 54MM*23MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 56MM*22MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 56MM*22MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 56MM*24MM
|
Facility
|
OP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem Medicaid |
$2,676.32
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Humana KY Medicaid |
$2,676.32
|
| Rate for Payer: Kentucky WC Medicaid |
$2,703.55
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,730.01
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD HUMERAL 56MM*24MM
|
Facility
|
IP
|
$7,782.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,011.69 |
| Max. Negotiated Rate |
$7,470.96 |
| Rate for Payer: Aetna Commercial |
$5,992.33
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$6,070.16
|
| Rate for Payer: Cash Price |
$3,891.12
|
| Rate for Payer: Cigna Commercial |
$6,459.27
|
| Rate for Payer: First Health Commercial |
$7,393.14
|
| Rate for Payer: Humana Commercial |
$6,614.91
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$6,381.44
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$5,743.30
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,334.68
|
| Rate for Payer: Ohio Health Choice Commercial |
$6,848.38
|
| Rate for Payer: Ohio Health Group HMO |
$5,836.69
|
| Rate for Payer: Ohio Health Group PPO Differential |
$1,556.45
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$1,011.69
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$2,412.50
|
| Rate for Payer: PHCS Commercial |
$7,470.96
|
| Rate for Payer: United Healthcare All Payer |
$6,848.38
|
|
|
HEAD LEGACY COCR 12/14 22MM +0
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 22MM +0
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 22MM +8
|
Facility
|
OP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem Medicaid |
$1,499.83
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Humana KY Medicaid |
$1,499.83
|
| Rate for Payer: Kentucky WC Medicaid |
$1,515.10
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,529.93
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
|
HEAD LEGACY COCR 12/14 22MM +8
|
Facility
|
IP
|
$4,361.25
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$566.96 |
| Max. Negotiated Rate |
$4,186.80 |
| Rate for Payer: Aetna Commercial |
$3,358.16
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$3,401.78
|
| Rate for Payer: Cash Price |
$2,180.62
|
| Rate for Payer: Cigna Commercial |
$3,619.84
|
| Rate for Payer: First Health Commercial |
$4,143.19
|
| Rate for Payer: Humana Commercial |
$3,707.06
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$3,576.22
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$3,218.60
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$1,308.38
|
| Rate for Payer: Ohio Health Choice Commercial |
$3,837.90
|
| Rate for Payer: Ohio Health Group HMO |
$3,270.94
|
| Rate for Payer: Ohio Health Group PPO Differential |
$872.25
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$566.96
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$1,351.99
|
| Rate for Payer: PHCS Commercial |
$4,186.80
|
| Rate for Payer: United Healthcare All Payer |
$3,837.90
|
|
